Rapidly Progressive Memory Loss, Mood Change, Mutism, and Abnormal Movements

A 24-year-old woman sought care for 2 weeks of disorientation and short-term memory difficulties, as well as diffuse tremor of all extremities. She returned with further decline in memory and new severe headaches. She had intermittent agitation and emotional outbursts of crying or laughing, insomnia, spells consisting of disorganized speech and episodes of intermittent right gaze deviation with facial twitching and lip smacking. She was nearly mute. Her appetite had decreased and she had not had a bowel movement in several days. She was noted to have significant tachycardia and was intermittently febrile. Within several days she became unresponsive to all external stimuli, with nonpurposeful eye movements and frequent dyskinesias observed, and ultimately required ventilator support. Testing of the cerebrospinal fluid showed 236 white blood cells/µL, mildly increased protein concentration of 50 mg/dL, and normal glucose values. Electroencephalography initially demonstrated generalized slowing and generalized periodic epileptiform discharges and was also notable for an extreme delta brush pattern. Bilateral ovarian masses were identified on pelvic ultrasonography, and subsequent computed tomography of the abdomen and pelvis showed bilateral teratomas. An autoimmune encephalitis autoantibody panel was positive for antibodies targeting the N-methyl-d-aspartate receptor in the serum and cerebrospinal fluid, by both cell-based and immunofluorescence assays. The patient was diagnosed with anti- N-methyl-d-aspartate receptor encephalitis. The patient initially received intravenous methylprednisolone, followed by intravenous immunoglobulin. Benzodiazepines and propranolol were used to manage agitation and dysautonomia. Antiepileptic drugs were initiated for seizures. She required mechanical ventilation and parenteral nutrition given her persistent profound encephalopathic state. She underwent left ovarian cystectomy and right salpingo-oophorectomy. This patient’s history highlights the progressive clinical features characteristic of anti- N-methyl-d-aspartate receptor encephalitis and the long but often complete or near-complete recovery.

Case Report on Paranoid Schizophrenia with Capgras Syndrome

Paranoid is the most common delusion in people living with schizophrenia spectrum disorders which are present in about half of all people seeking treatment for a psychotic disorder. Schizophrenia is a persistent mental illness characterized by a wide range of symptoms, including delusions, hallucinations, disorganized speech or behavior, and cognitive impairment. Capgras syndrome is a form of the delusional belief in which a person has been replaced by an imposter. It can be seen in mental disorders as well as in central nervous system diseases in the form of neurodegenerative and non- neurodegenerative diseases The Capgras Syndrome is not an unusual condition, but an infrequent one which is possibly often unnoticed. A 48- years- old woman was admitted in female psychiatric ward with known case of paranoid schizophrenia with capgras syndrome. In the present case, the treatment approach was mainly somatic therapy i.e. psychopharmacotherapy, Electro convulsive Therapy (ECT) and psychological therapy. Psychiatric nurses have to play an important role to identify the symptoms and they should think critically, take action immediately to provide care to such type of patients.

Teenager with paranoia and hallucinations preceded by a decline in academic and social functioning

Schizophrenia is a primary psychotic disorder characterized by two or more of hallucinations, delusions, disorganized speech, disorganized or catatonic behavior, and/or negative symptoms. At least one of the symptoms must be hallucinations, delusions, or disorganized speech. There must be continuous signs of the disturbance for at least six months, although the duration may be shortened with appropriate treatment. The symptoms of schizophrenia typically begin between the ages of 15 and 30 years. Active symptoms are typically preceded by a prodromal phase, marked by a decline in academic and social functioning. The assessment of an adolescent with suspected schizophrenia should include a psychiatric assessment and complete medical history to rule out medical conditions that mimic psychosis. The primary treatment is antipsychotic medications. Adjunctive psychological and social interventions can improve treatment adherence and clinical outcomes.

Autism Spectrum Disorder and Early-Onset Psychoses

This chapter covers the profiles of difficulties in relating, to other people and the world, that are included in the international schemes of classification as spectra of autism, schizophrenia, and psychosis. In autism, there is a marked reduction in, or oddity of, social communication, and an increase of repetitive and stereotyped behaviours. In psychoses, including schizophrenia and catatonia, there is disordered testing of reality (resulting in hallucinations, delusions, and disorganized speech), and deficits in volition (involving apathy, social isolation, and lack of initiative). These are described as they present in children and young people, together with their prevalence and the coexistent problems of emotion and behaviour that occur frequently. The longitudinal course is considered up to the transition into adult life. Potential causes and pathophysiology are considered in so far as they apply specifically to these disorders.

Acute psychosis in COVID-19: Is it due to favipiravir treatment or acute viral illness?

Introduction: In this report, we present a case of acute psychosis that occurred after the loading dose of favipiravir, one of the most prescribed antiviral drugs in many countries, in a patient with COVID-19. Case presentation: A 31-year-old female was readmitted to the emergency department after three days of sleep disturbance, intermittent paranoid delusions, auditory hallucinations, and agitation that started after the favipiravir treatment was initiated. A physical examination revealed disorganized speech, distorted orientation, and agitation. All laboratory tests, including drug screening and cerebrospinal fluid analysis, were normal. After excluding all the other causes of acute psychosis, favipiravir treatment was discontinued, antipsychotic treatment was started, and the patient was admitted to the psychiatric ward. The symptoms resolved on the second day of hospitalization. Although acute viral illness does seldomly cause psychosis in patients with increased inflammatory response, in the presented case, none of the inflammatory markers were positive and acute psychosis was attributed to the loading dose of favipiravir. Conclusion In conclusion, emergency department physicians should be aware of this rare adverse effect and prescribe cautiously to patients at a high risk of psychosis.

Using systemic functional linguistics (SFL) to explore topic shifts in the spontaneous interaction of schizophrenia: Cohesion and thematic structures

This study investigates the linguistic patterning that created shifts in the topic of spontaneous interactions of speakers with schizophrenia. The psychiatric category of disorganized speech in schizophrenia may be manifested in language across (derailment) or within (incoherence) clauses through unexpected topic shifts. Topic switching was examined for cohesion (Halliday, M. A. K. & Hasan, Ruqaiya. 1976. Cohesion in English. London: Longman; Martin, J. R. 1992. English text. Philadelphia, Amsterdam: John Benjamins Publishing Company; Martin, J. R., Rose, David. 2007. Working with discourse: Meaning beyond the clause. London: Continuum) and thematic structures (Daneš, Frantisek. 1974. Functional sentence perspective and the organization of the text. In Frantisek Daneš (ed.), On subject and theme. Amsterdam: John Benjamins; Martin, J. R. 1992. English text. Philadelphia, Amsterdam: John Benjamins Publishing Company; Martin, J. R., Rose, David. 2007. Working with discourse: Meaning beyond the clause. London: Continuum; Halliday, M. A. K. & Matthiessen, Christian. 2013. An introduction to functional grammar, 4th revised edn. London: Routledge), within the framework of systemic functional linguistics (SFL). Three patients diagnosed with schizophrenia conversed individually with a psychiatrist who elicited information on various topics, e.g. background information, hobbies, etc. Interviews were videotaped, and recorded. Recordings were transcribed by the researcher and divided into clauses, which were analyzed and coded for consistency of field, cohesion and thematic structures. Findings revealed that speakers did not make use of linguistic features simultaneously to initiate topics. Topic shifting was marked by moving fields with atypical reference, intertwining of participant chains, and lexical items appearing out of context. Speakers created discontinuous participant chains across Themes and departed from main thematic sequences of linear progression and Theme iteration. The specific linguistic findings correspond to and the clinical description of schizophrenia.

Nomınal and Verbal Predıcate Use in Schızophrenıa

Objective. Schizophrenia’s first characteristics invokes the notion of disordered thought and language. Accordingly one of several diagnostic characteristics of schizophrenia is an impairment of verbal communication. To determine the detailed nature of language impairments taking into consideration these problems the aim of the present study was to analyze nominal and verbal predicate use produced by schizophrenic patients and control group during their speech as both predicates require different processings. Materials & Methods. Fifty patients with schizophrenia diagnosed according to DSM-IV criteria were included into the study and compared to fifty healthy subjects matched for age, sex and education level with the patients participated in the study. The subjects’ speech was evaluated by using picture description test, picture story telling test, subject-based narration test and free verbal narration test. The data consisted of 8–10 minute recorded interviews. The recordings were transcribed based on Du Bois’ Discourse Transcription Symbols and analyzed statistically and linguistically. Results. The results showed that the number of nominal and verbal predicates used by the patients with schizophrenia differed from the control group. Schizophrenia patients preferred nominal predicates more than control group in all tests. However, control group used significantly more verbal predicates in all tests. Conclusions. In this study it was hypothesized that language used by the patients with schizophrenia plays a central role in the this disease than commonly supposed and the phenomena of schizophrenic language can be regarded as reflections of a more basic disturbance of thought. At the end of the study based on this hypothesis patients were concluded to have simplified speech in addition to the disorganized speech defined in the field. The reason for this simplification is thought to be because of the predicate processing in the brain. The complement of a verb is always a noun phrase, which can be simple or complex, the patients tended to use nominal predicates more as it did not require any constituents and thus they simlified their speech because of their language and thought disorders.

S117. DOES ADDING AUTOMATED ANALYSIS OF SPEECH COHESION TO DIMENSIONALIZED R-PAS COGNITIVE CODES IMPROVE OUR ABILITY TO ASSESS DISORGANIZED THINKING?

Background Research is increasingly pointing toward the need for a dimensional, rather than categorical, conceptualization of psychopathology. This is particularly true within the literature on psychosis and related disorders. Taking a dimensional approach to conceptualizing psychosis requires deconstructing its components in assessment. The Rorschach Performance Assessment System (R-PAS) contains meta-analytically supported scales with international norms that are used to categorically rate signs of disordered thinking and perceptions in individuals’ responses to the Rorschach inkblots. Recently, a new dimensionalized set of scales called the Scales of Problematic Communication and Thinking (SPCT) have been developed for R-PAS with three main components: Disturbed and Confusing Communication, Illogical Verbal Justification, and Incongruous Perceptual Combinations. Research also suggests that linguistic measures of speech cohesion can be used to successfully predict conversion to psychosis in clinical high-risk patients and may be more related to stable neurocognitive deficits than clinical measures of disorganized speech. Coh-Metrix, an automated speech analysis software, provides over 100 specific measures of linguistic cohesion, such as connectivity, syntax simplicity, and referential cohesion. The purpose of this presentation is twofold: (a) to report recent findings showing the SPCT provides incremental validity over the traditional R-PAS measure of disordered thinking in predicting clinician ratings of disorganized thinking on the PANSS and (b) to determine if Coh-Metrix measures of linguistic cohesion provide incremental validity to SPCT ratings in predicting these PANSS ratings. Methods R-PAS protocols from a maximum-security inpatient forensic hospital (N = 91) aged 19 to 80 years (M=40) and predominantly male (89%) were coded for thinking and perceptual disturbances using the R-PAS traditional measure of disordered thinking and the 6-point dimensional SPCT measure. The patients’ primary clinician provided PANSS ratings. Protocols will be coded for speech cohesion using 15 indices from the automated speech analysis software Coh-Metrix, which were chosen based on a literature review. Results Interrater reliability was excellent for the SPCT ratings (ICC = 0.97) and good for the PANSS clinician ratings (ICC = 0.71). In a previous study, SPCT ratings showed significant associations with the clinician ratings of disorganized thinking on the PANSS (r = 0.42, p < 0.01, N = 90); hierarchical regression analyses demonstrated incremental validity over the traditional R-PAS measure of disordered thinking (ΔR = 0.28, p < 0.01). Using hierarchical regression analyses, the Coh-Metrix indices of cohesion are predicted to provide incremental validity to the SPCT ratings. Discussion The SPCT shows promise as a reliable and valid dimensionalized measure for assessing the continuum of clear thinking to psychosis-level disturbances. The measures of linguistic cohesion provided by Coh-Metrix have the potential to offer clinicians a quick, efficient, and objective method for assessing disorganized thinking. The R-PAS international norms are currently being coded for SPCT and, if Coh-Metrix measures provide incremental validity, will be coded for these measures as well. Using these measures in combination with SPCT ratings can provide clinicians with a clearer understanding of this significant component of psychosis.

Emotion Dysregulation and Psychosis Spectrum Disorders

Psychosis spectrum disorders (PSDs) are complex, highly heritable psychiatric conditions with high economic and societal costs. PSDs have historically been conceptualized as neurocognitive disorders in which psychotic episodes and impairments in social and emotional functioning are attributed to deficits in neurocognition. Although cognitive pathways play an important role in the etiology and presentation of PSDs, recent research suggests that interrelations between cognition and emotion are highly relevant. Moreover, aberrant emotion regulation likely plays a significant role in the presentation of PSDs. Emotion dysregulation (ED) may underlie and exacerbate both negative and positive symptoms in PSDs, such as blunted affect, avolition, disorganized speech and behavior, poor social cognition, and delusions and hallucinations. Advances in measurement of emotion dysregulation—including self-reports, behavioral paradigms, neuroimaging paradigms, and neurophysiological assessment—have informed etiological models of emotion dysregulation in PSDs. This chapter reviews research on emotion regulation and dysregulation in PSDs. Notably, more severe presentations of emotion symptoms and greater emotion regulation impairments are associated with worse outcomes in PSDs. It may therefore be the case that focusing on ED as an early risk factor and intervention target could improve outcomes and prevention approaches for psychotic disorders.

O Poder Psicoativo dos Alimentos: Análise de um Caso de Intoxicação com Noz-Moscada

Ingestion of high doses of nutmeg causes potentially serious and disabling medical and psychiatric consequences. No isolated component of nutmeg has been identified as responsible for all symptoms observed during intoxication, however myristicin, one of the essential oil’s components of this spice, is believed to be responsible for most psychoactive effects, although the exact mechanism is not known. Other constituents, such as elemicin, may also be involved. Symptoms of intoxication begin three to six hours after ingestion, resolve within the first 48 hours, and usually leave no sequelae. In this paper we present the case of a patient who after consuming 18 to 28 g of nutmeg developed a severe psychotic episode, with disorganized speech, psychomotor agitation and mystical/grandiose delusional ideation. The symptoms resolved quickly, and after one year of clinical stability without therapy, was discharged from the specialist consultation.